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Your Questions Answered: CLUSTER HEADACHES

Lipton, Richard B. M.D.

Department: Ask the Experts

Answers on shingles, insomnia, sciatica, and cluster headaches

Richard B. Lipton, M.D., professor and vice chair of neurology at the Albert Einstein College of Medicine in the Bronx, N.Y., is director of the Montefiore Headache Center.

Q I've been experiencing cluster headaches for years. Is there anything I could do to prevent them?

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A Cluster headaches derive their name from the fact that the headaches come in clusters. Attacks may occur several times a day for weeks or months, followed by long headache-free periods.

The duration of individual headaches tends to be short: 30 to 90 minutes. But they are agonizing. People have described them as feeling like a hot poker in the eye.

Severe one-sided pain is often associated with other features. These can include drooping of an eyelid, eye redness and tearing, and nasal stuffiness—all on the same side as the head pain.

Cluster headaches are almost always benign. But there are some serious conditions that can cause a similar pattern of headaches. Therefore, people with a new onset of cluster headaches should have an MRI.

As with migraines, treatment can be abortive or preventive. Because cluster headaches are relatively short-lived but intense, abortive therapies need to work quickly. One very effective acute treatment is oxygen, administered at home by face mask; it typically works within 10 minutes.

Another very effective therapy is injectable sumatriptan (Imitrex), which is also used for migraines. That works in about 5–10 minutes. There is also a nasal spray, which is not as fast as oxygen or sumatriptan injections.

The mainstay of treatment, though, is prevention.

Prednisone and other steroids work very quickly to turn off a cluster attack. But these are powerful drugs that shouldn't be taken on a long-term basis.

For the long term, a calcium channel blocker known as verapamil works very well—but it takes a couple of weeks to kick in. So, a new patient will be started on prednisone and verapamil simultaneously; then the prednisone can be tapered off.

Patients with cluster headaches should probably be managed by a neurologist, since most primary care physicians will see only one or two patients with this problem in their whole career.

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